It has been said that we in health care carry a backpack of sorrows.
There is a sanctity to being on the inside, trusted to care for people in their weakest, darkest and most vulnerable moments. When it feels like control is gone, we steady our voices even when we too feel scared.
Oncologists like myself are no strangers to death. It is all too familiar. We give our patients the best that medicine has to offer; we cure them if we can. When our efforts fail, we relieve their pain and ease their suffering. And when they pass away, we grieve. With their friends, colleagues, family members, partners and spouses, we grieve.
Almost by definition, a time of mourning is a time of gathering. Both to grieve and to console, we must be present with one another. I try to be there for my patients and their families and to answer all of their questions with candor and concern.
Seventeen years ago, I was a senior psychiatry resident, moonlighting on weekends in the psych unit at a small rural hospital. Usually the unit was quiet. In this remote corner of northern Canada, we were taught to value resources and avoid “unnecessary” psychiatry admissions.
Arriving one rainy Friday, I headed to the ER to let them know I was there. Among the mostly frail, elderly patients, one person stood out: a healthy-looking woman in her early thirties, about my age.
I keep having this dream where I’m trying to call 911, and I can’t. I can’t seem to get the phone to work. I become panicked, and I can’t breathe. My heartbeat pounds in my ears, and I feel the sharp taste of bile in my throat.
When I wake up, that shaky feeling of fear and impotence clings to me. I don’t ever remember what was wrong in the dream–why I needed to call 911. I just remember not being able to.
A few years ago, a Chicago-area fertility clinic ran a series of radio ads at the same early hour each morning. For weeks, I woke to a woman’s energetic voice cutting through the fog of my semiconsciousness, announcing her gratitude to the center’s reproductive specialists. “Without them,” she proclaimed brightly, “my baby wouldn’t have my blue eyes and my husband’s wide smile.”
Before stepping into Jasmin’s room, I slathered my hands with cold Purell and began the mundane ritual of donning my PPE. The smell of alcohol filled my nostrils as I grabbed a gown and the paper bag containing my N-95 mask and face shield. Like a seasoned soldier preparing for battle, I put on my gear with ease. With my gloves glued to my skin by sanitizer, I rapped on Jasmin’s door, asking permission to enter.
“Nothing in life is certain except death and taxes!” my dad often crows.
This phrase takes me back to my boyhood, watching the Cricket World Cup matches with him. Time and again, I would pray fervently for an Indian win, but watch in increasing desperation as India threw away an insurmountable lead and snatched defeat from the jaws of victory.
“How are you surviving the COVID-19 pandemic?”
Lately, this is my new opening question with patients who come for a routine office visit. As a cardiologist in a community-hospital setting, I see mostly elderly patients.
When I ask my patients this question as they sit on the exam table wearing their brightly colored masks, they usually answer, “I don’t go out much. When I do, I wear a mask and practice social distancing.”
In recent weeks, they’ve begun asking me questions–about the COVID-19 vaccine. Having just received the vaccine myself, I can describe the experience firsthand.
The year is 2015, and I’m on my thirteenth surgical mission, but my first to Venezuela. I am a plastic surgeon, traveling with a nonprofit that offers free plastic surgery for people with birth defects such as cleft lip. We’re making a two-week visit to the coastal city of Cumaná, 250 miles east of Caracas.
Halfway through our first day of surgery, I’m asked to come out to the waiting area to assess a young girl named Vanessa, whose mother has brought her as a walk-in patient.
In the time of COVID-19, healthcare workers are stepping up to care for massive numbers of patients. Often, they’re doing this without adequate resources. At the beginning of the pandemic, our hospital administration referred to this as “crisis standard of care”–which the US Institute of Medicine defines as “a substantial change in…the level of care it is possible to deliver, made necessary by a pervasive or catastrophic disaster.”
For many American doctors this model of care is new, but I would argue that for most health workers worldwide, it isn’t new at all.
The new patient’s name is Emmanuel. He was sent from his nursing home to our emergency room with a cough and fever. The oxygen level in his blood is well below normal, and he’s gasping for air.
It’s my third week in the local community hospital ER. I’ve been putting in extra on-call time during the COVID pandemic. It’s been rough to get back into the emergency setting while continuing my day job as a family doctor and medical educator. I’ve been sharing admissions with the hospitalist, who’s joined me in the on-call room.
“I’ll take him,” I tell my colleague.
The miracle was that this baby had lived at all. His mother called 911 while in labor, with heroin easing her pain and numbing her conscience. The paramedics arrived at the empty warehouse where she’d been living. She delivered her newborn son in a toilet. The paramedics scooped him out, cut his umbilical cord with her razor blade and brought mother and son to our hospital.
The fact that all this took place should be remarkable.
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